MEDICARE: JAMES L. ABBOTT, OD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	338	AZ

General Provider Information

NPI Number	:	1609040187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES L. ABBOTT, OD, PC

Provider Business Mailing Address
First Line	:	1919 E MCKELLIPS RD
Second Line	:	SUTIE 103
City	:	MESA
State	:	AZ
Zip	:	85203-2844
Country	:	US
Telephone Number	:	480-844-2286
Fax Number	:	480-610-6641

Provider Business Practice Location Address
First Line	:	1919 E MCKELLIPS RD
Second Line	:	SUTIE 103
City	:	MESA
State	:	AZ
Zip	:	85203-2844
Country	:	US
Telephone Number	:	480-844-2286
Fax Number	:	480-610-6641

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES L. ABBOTT II
Credential	:	OD
Telephone Number	:	480-844-2286

Provider Enumeration Date	:	04/16/2008
Last Update Date	:	04/16/2008

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